There are significant ethnic differences in cardiovascular‐renal demographics around the world, and hypertension is one of the most powerful risk factors associated with these demographic differences. Both compared with other regions and within Asia, there are significant country‐specific, regional, and ethnic differences in blood pressure (BP) control status. To achieve effective protection against cardiovascular‐renal events in Asia, it is important that Asian characteristics of hypertension‐related cardiovascular‐renal disease are identified and addressed. The Hypertension, brain, cardiovascular and renal Outcome Prevention and Evidence in Asia (HOPE Asia) Network was officially established in 2018 [503] . Its mission is to improve the management of hypertension and organ protection with the ultimate goal of achieving zero cardiovascular events in Asia. Activity is based on three initiatives: (1) the examination and analysis of existing evidence related to hypertension; (2) formation of a consensus regarding hot clinical topics in hypertension; and (3) conducting Asia‐wide clinical studies in hypertension. Two additional goals were added in 2020: to disseminate evidence and to foster young researchers (Figure 8.1) [504, 505]. The HOPE Asia Network is proud to be a member organization of the World Hypertension League (WHL) and looks forward to contributing actively to the WHL’s mission of confronting the global epidemic of hypertension and the high burden of premature death and disability that results from this condition [506–508]. Since November 2019, the HOPE Asia Network has also been an affiliated society of the International Society of Hypertension (ISH). Groups of Asian hypertension researchers (e.g. the Asia BP@Home investigators and the COME Asia‐MHDG [Characteristics on the ManagEment of Hypertension in the Asia‐Morning Hypertension Discussion Group]) have studied the characteristics of hypertension and cardiovascular‐renal disease in Asian populations [270, 320, 442, 443, 475, 509]. Collaboration between these groups was instrumental in forming the HOPE Asia Network. In a previous survey of awareness of hypertension management in Asia, 87% of all physicians who responded said that they did take the Asian lifestyle and Asian‐specific characteristics of hypertension into consideration, and 92% recognized the need for an Asian‐specific guideline for the management of hypertension (Figures 8.2 and 8.3) [510] . Figure 8.1 Missions of the Hypertension, brain, cardiovascular and renal Outcome Prevention and Evidence in Asia (HOPE Asia) Network. Source: Kario. J Clin Hypertens. 2018; 20: 212–214 [503] and Kario and Wang. JACC Asia. 2021; 1: 121–124 [505] . HOPE Asia Network resources and up‐to‐date information relating to hypertension management in Asian countries can be found at the group’s website: https://www.hope‐asia‐network.com. The first HOPE Asia Network project determined the current status and evidence relating to home BP in 12 Asian countries based on a search of the medical literature [511] . Subsequently, several meetings were held with the purpose of achieving a consensus on home BP‐guided clinical management of hypertension in Asia [184, 512], and on locally based recommendations for ambulatory BP monitoring (ABPM) [512, 513]. Research by the HOPE Asia Network showed that there are marked differences in the current prevalence and awareness of hypertension, the proportions of patients with treated and controlled hypertension (Figure 8.4) [148, 511] , and in the usage of common antihypertensive drugs between countries in Asia (Figure 8.5) [504] . The group is also active in research and review in the hypertension field, especially concerning clinically important “hot topics” relating to the management of hypertension and the prevention of cardiovascular‐renal disease in Asia. These efforts have been supported by the Journal of Clinical Hypertension, which published the first “Asia Special Issue” in March 2020 [185, 261, 287, 378, 477, 504,514–537]. This was repeated in March 2021 [513,538–571], and will be supported by the journal on ongoing basis. Figure 8.2 Asian physicians’ knowledge of hypertension management. A total of 133 physicians attending conferences in Asia over the period March to May 2014 responded to the questionnaire. Physicians were from China (n = 33), Taiwan (n = 29), Indonesia (n = 8), Thailand (n = 7), Vietnam (n = 7), Myanmar (n = 7), Pakistan (n = 1), Korea (n = 3), Philippines (n = 3), Malaysia (n = 1), Egypt (n = 1), Hong Kong (n = 1), Saudi Arabia (n = 1), and unknown (n = 28). ABPM, ambulatory blood pressure monitoring; BP, blood pressure. Source: Hoshide et al. Curr Hypertens Rev. 2016;12:164–168 [510] . Republished with permission of Bentham Science Publishers Ltd. The initial focus of the HOPE Asia Network has been on home BP values because we consider that a home BP‐guided approach is the most effective and practical in clinical practice. Accordingly, HOPE Asia Network expert panel consensus recommendations for home blood pressure monitoring (HBPM) in Asia have been published, focusing on the practical usage of HBPM (Table 8.1) [183] . Specific research activity by the HOPE Asia Network includes the Asia BP@Home study, which investigated the current status of home BP control in different Asian countries [521, 572, 573]. This is the first HBPM study to use the same device and monitoring schedule across all countries and study centers. Figure 8.3 Asian physicians’ knowledge of hypertension management (n = 133). BP, blood pressure. Source: Hoshide et al. Curr Hypertens Rev. 2016;12:164–168 [510] . Republished with permission of Bentham Science Publishers Ltd. Figure 8.4 Awareness, treatment, and control rate of hypertension in Asian countries. NA, data not available. Source: Kario and Wang. Hypertension. 2018; 71: 979–984 [148] . Figure 8.5 Usage of antihypertensives and proportion of monotherapy by country. ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker. Source: Kario et al. J Clin Hypertens. 2020;22:331–343 [504] . It is well established that the characteristics of hypertension and its related diseases are markedly different in Asians compared with Caucasians and Blacks (Table 8.2) [138, 155, 179]. Several factors contribute to hypertension and cardiovascular disease in Asia (Figure 8.6) [504, 505]. For example, the phenotypes of cardiovascular disease, stroke, and heart failure that are closely associated with high BP are more common in Asia (Figure 8.7) [574] . In the recent prospective, Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study in an Asian population, the incidence of stroke in treated patients with hypertension was around 2.8‐times higher than that of myocardial infarction (2.92 vs. 1.03 per 1000 person‐years) (Table 8.3) [56] . The incidence of coronary artery disease (composite of myocardial infarction and angina pectoris with intervention) (2.80 per 1000 person‐years) was almost comparable to that of stroke. Furthermore, the slope of the association between BP and cardiovascular events is steeper in Asians compared with Western populations (Figures 8.8 and 8.9) [575, 576]. Thus, the impact of 24‐hour hypertension control would be greater in Asians [138, 169, 179]. The impact of obesity on high BP may be different between Asian and Caucasian individuals. Asians are likely to develop high BP even in the presence of mild obesity. Looking at the risk of elevated BP/stage 1 hypertension (previously known as prehypertension), the impact of a body mass index (BMI) of 25 kg/m2 in a Japanese population was almost comparable to that of a BMI of 30 kg/m2 in a US population (Figure 8.10) [577, 578]. Table 8.1 Summary of recommendations for home blood pressure (BP) monitoring in Asia. Source: Park et al. J Hum Hypertens. 2018; 32: 249–258 [183] .
CHAPTER 8
Asia perspectives
What is the HOPE Asia Network?
HOPE Asia Network achievements
Characteristics of cardiovascular disease in Asia
Obesity and salt intake in Asia
Recommendations
Class of recommendation
Level of evidence
1. HBPM is an accurate adjunct for diagnosing hypertension when a validated device is used and the measurement is performed correctly
I
B
2. Method of measuring home BP:
I
B 
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